Splenic Abscess with Intralesional Gas

A female patient in her 60s developed severe deterioration of her general condition, fever, and pain in her left flank. She was undergoing oncological treatment for advanced pancreatic ductal adenocarcinoma, with infiltration of the splenic vein and retroaortic soft-tissue masses. Computed tomography demonstrated a gangrenous splenic abscess with intralesional gas (Figure). Blood cultures detected Clostridium perfringens. The etiology of this extremely rare infectious manifestation is presumed to be endogenous translocation from the gastrointestinal tract in the setting of immune compromise. Empirical therapy with piperacillin/tazobactam already resulted in a clinical improvement, and sonography showed no progression in lesion size; thus, since a polymicrobial infection could not be definitively ruled out, a focus on penicillin G—although reasonable after pathogen identification—was not pursued. However, clindamycin was added in compliance with guidelines. At the patient’s request, surgical or interventional drainage (the guideline-based treatment) was foregone, and after 2 weeks of intravenous treatment, clindamycin was continued orally to allow the patient to be discharged home in the palliative setting. Despite suppression of the Clostridium perfringens infection, the patient died after an additional 4 weeks due to progression of the underlying malignant disease.

Figure

Contrast-enhanced computed tomography of the abdomen in the venous phase, transverse plane

Jan-Felix Kruschina, Dr. med. Gwendolyn Scheumann, Klinik IB für Innere Medizin, Bundeswehrzentralkrankenhaus Koblenz

Dr. med. Dominic Rauschning, Klinik IB für Innere Medizin, Bundeswehrzentralkrankenhaus Koblenz und Medizinische Klinik I für Innere Medizin, Universitätsklinik Köln, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Kruschina JF, Scheumann G, Rauschning D: Splenic abscess with intralesional gas. Dtsch Arztebl Int 2025; 122: 668. DOI: 10.3238/arztebl.m2025.0135